Excerpts: "We are in the midst of a revolution in sexual and romantic tastes unlike any other in history, a social experiment being performed on children and teenagers... What clinicians don’t know much about, yet, is how we shall help teenagers, whose sexual tastes are being influenced by porn, because this level of porn exposure is quite new. Will these influences and tastes turn out to be superficial? Or will the new porn scenarios deeply embed themselves because the teen years are still a formative period?"

We are in the midst of a revolution in sexual and romantic tastes unlike any other in history, a social experiment being performed on children and teenagers, captured in a powerful, poignant scene in the recent British documentary InRealLife, about the effects of the internet on teenagers, directed by Baroness Beeban Kidron.

In the film, a 15-year-old boy of impressive frankness articulates a process that is going on in the lives of millions of teen boys, whose sexual tastes are being shaped in large part by their 24/7 access to internet porn. He describes how porn images have moulded his “real life” sexual activity:

“You’d try out a girl and get a perfect image of what you’ve watched on the internet … you’d want her to be exactly like the one you saw on the internet … I’m highly thankful to whoever made these websites, and that they’re free, but in other senses it’s ruined the whole sense of love. It hurts me because I find now it’s so hard for me to actually find a connection to a girl.”

What is so poignant about the scene, is how he has at a young age discovered that his sexual tastes and romantic longings have become dissociated from each other.Meanwhile, we learn from this and other films that the girls who are the potential mates of such boys, have “downloaded” on to them the expectation that they play “roles” written by pornographers.

The teenager’s distress represents one of the paradoxes of porn. Why should it make it hard for him to be turned on by a girl, and not easier? Once, porn was used by teens to explore, prepare and relieve sexual tension, in anticipation of a real sexual relationship. Today, there is something about the new, internet-based forms of porn that causes porn not to prepare a person for a sexual relationship, but rather to supplant it. Many young men even say they prefer it to sex and relationships with people, with all their hassles. Perhaps these are the grumblings of boys, low in the dominance hierarchy, unable to “get” a girl. But some, like the able teen in the film, find that even though they can “get” a girl, when they do, their sexuality is “not working right”.

The young man’s complaint had a familiar ring, albeit with a twist. In the mid-1990s I, and other psychiatrists, began to notice the following pattern. The typical example would be an adult male, in a happy relationship, who described getting curious about porn on the burgeoning internet. Most sites he found boring, but he soon noticed several that fascinated him to the point that he began craving them. The more he used the porn, the more he wanted to. The problem was not just the time spent on the internet. He had now acquired a taste for a kind of pornography that, to a greater or lesser degree, ultimately affected his relationships and sexual potency. This man was not fundamentally immature, socially awkward, or withdrawn from the world into a massive pornography collection that served as a substitute for relationships with real women. Typically such men were rather pleasant, generally thoughtful, and in reasonably successful relationships or marriages. Nor did they have addictions. Typically, the man would report with telling discomfort, that he found himself spending more and more time on the internet, looking at pornography and masturbating.

But most striking were their reports, almost in passing, of their increasing difficulty in being turned on by their actual sexual partners, spouses or girlfriends, though they still considered them objectively attractive. When I asked if this phenomenon had any relationship to viewing pornography, they answered that it initially helped them get more excited during sex but over time had the opposite effect. Now, instead of using their senses to enjoy being in bed, in the present, with their partners, lovemaking increasingly required them to fantasize that they were part of a porn script. Some – like the teenage boy in InRealLife – tried to persuade their lovers to act like porn stars, and they were increasingly interested in “fucking” as opposed to “making love”. Their sexual fantasy lives were increasingly dominated by the scenarios that they had, so to speak, downloaded into their brains, and these new scripts were often more primitive and more violent than their previous sexual fantasies. I got the impression that any sexual creativity these men had was dying and that they were becoming addicted to internet porn. But unlike the teenage boys, whose sexual tastes are formed by porn, these men had previous experiences to fall back on. The teenage boys of today do not, and this is the social experiment this essay will try to shed some light upon.

The idea that the sexual tastes might be flying, for some, in the face of common sense, and an argument made by evolutionary psychologists, that asserts that the sexual urge is the product of evolution, essentially unchanged for hundreds of thousands of years, precisely because the brain, and its structure and function – its “wiring” – is essentially unchanged for all that time as well. However, we have recently learned that not only can the brain change, but that it operates by changing. The term for the property that allows the brain to change its structure and function is “neuroplasticity”, and it changes in response to mental experience. “Neuro” is for neuron, and “plasticity” means plastic in the sense of malleable, changeable, adaptable. The evolutionary biologists are correct that key aspects of our brains are much like that of distant ancestors; but they have often left out that the greatest gift from our ancestors, the most distinguishing property of the human brain, is the extent of its plasticity.

Neuroplastic change goes on at a microscopic level, inside the brain, in the neurons. But even long before neuroplasticity was discovered, careful observers understood human beings exhibit an extraordinary degree of sexual plasticity compared with other creatures. We vary in what we like to do with our partners in a sexual act. We vary where in our bodies we experience sexual excitement and satisfaction. But most of all we vary in whom or what we are attracted to. People often say they find a particular “type” attractive, or a “turn-on”, and these types vary immensely from person to person.

For some, the types change as they go through different periods and have new experiences. One homosexual man had successive relations with men from one race or ethnic group, then with those from another, and in each period he could be attracted only to men in the group that was currently “hot”. After one period was over, he could never be attracted to a man from the old group again. He acquired a taste for these “types” in quick succession and seemed more smitten by the person’s category or type (i.e. “Asians” or “African-Americans”) than by the individual. The plasticity of this man’s sexual taste exaggerates a general truth: that the human libido is not a hardwired, invariable biological urge but can be curiously fickle, easily altered by our psychology and the history of our sexual encounters. And our libido can also be finicky. Much scientific writing implies otherwise and depicts the sexual instinct as a biological imperative, an ever-hungry brute, always demanding satisfaction – a glutton, not a gourmet. But human beings are more like gourmets and are drawn to types and have strong preferences; having a “type” causes us to defer satisfaction until we find what we are looking for, because attraction to a type is restrictive: the person who is “really turned on by blondes” may tacitly rule out brunettes and redheads.

But sexual plasticity goes further still. Fetishists desire inanimate objects. The male fetishist can be more excited by a high-heeled shoe with a fur trim, or by a woman’s lingerie, than by a real woman. Some people seem to be attracted not so much to people as to complex sexual scripts, where partners play roles, involving various perversions, combining sadism, masochism, voyeurism and exhibitionism. When they place an ad in the personals, the description of what they are looking for in a lover often sounds more like a job description than like that of a person they would like to know. It is reasonable to ask whether our sexual and romantic plasticity is related to neuroplasticity. Research has shown that neuroplasticity exists throughout the brain. The brain structure that regulates instinctive behaviours, including sex, called the hypothalamus, is plastic, as is the amygdala, the structure that processes anxiety. Neuroplasticity is not, as some first thought, ghettoised in certain “higher” parts of the brain used for complex mental processes. Indeed, if one brain system changes, the systems connected to it must change as well. The brain is far more like a muscle than we thought: it is a use-it-or-lose-it brain. If we don’t use our circuitry for one mental function, because that function has fallen into disuse, the circuitry we used for it will end up processing the mental functions we are performing. Another major discovery is that when we learn we form new connections between neurons, based on the timing. “Neurons that fire together wire together.” Thus to take a simple case of Pavlovian learning, if we ring a bell a number of times before meat is given to a dog, soon the neurons that register the bell sound get connected to the neurons that trigger salivation. Next thing we know, the ringing of the bell leads directly to salivation, meat or no meat. If each time a young man goes online, he samples sexual images, soon, the computer itself can become “sexualised”, erotic, as we shall see, like a sex object.“The sexual instincts”, wrote Freud, “are noticeable to us for their plasticity, their capacity for altering their aims.” Freud was not the first to argue that sexuality was plastic – Plato, in his dialogue on love, argued that human Eros took many forms – but Freud laid the foundations for a neuroscientific understanding of sexual and romantic plasticity.

One of his most important contributions was his discovery of critical periods for sexual plasticity. Freud argued that an adult’s ability to love intimately and sexually unfolds in stages, beginning in the infant’s first passionate attachments to its parents. He learned from his patients, and from observing children, that early childhood, not puberty, was the first critical period for sexuality and intimacy, and that children are capable of passionate, protosexual feelings – crushes, loving feelings, and in some cases even sexual excitement. Freud discovered that the sexual abuse of children is harmful because it influences the critical period of sexuality in childhood, sometimes shaping our later attractions and thoughts about sex. The idea of the critical period was formulated by embryologists who observed that in the embryo the nervous system develops in stages, and that if these stages are disturbed, the animal or person will be harmed, often catastrophically, for life. Freud observed such stages apply after birth as well. What Freud said about the early stages of sexual development conforms to what we know about critical periods. They are brief windows of time when new brain systems and maps develop with the help of stimulation from the people in one’s environment.

Traces of childhood sentiments in adult love and sexuality are detectable in everyday behaviours. When adults in our culture have tender foreplay, or express their most intimate adoration, they often call each other “baby” or “babe”. They use terms of endearment that their mothers used with them as children, such as “honey” and “sweetie pie”, terms that evoke the earliest months of life when the mother expressed her love by feeding, caressing, and talking sweetly to her baby – what Freud called the oral phase, the first critical period of sexuality, the essence of which is summed up in the words “nurturance” and “nourish”. Being loved, cared for and fed are mentally associated in the mind and wired together in the brain in our first formative experience after birth,

When adults talk baby talk to each other, they are, according to Freud, “regressing”, moving from mature mental states of relating to earlier phases of life. In terms of plasticity, such regression, I believe, involves unmasking old neuronal pathways that then trigger all the associations of that earlier phase. Regression can be pleasant and harmless, as in adult foreplay, or it can be problematic, as when infantile aggressive pathways are unmasked and an adult has a temper tantrum.

Even “talking dirty” shows traces of a child’s view of the genitals, and for whom the idea that Mommy permits Daddy to insert his “dirty” organ for urination in a hole that is very close to her bottom, used for defecation, is disgusting. In adolescence after a critical period of sexual plasticity the brain reorganises again, so that the pleasure of sex becomes intense enough to override any disgust.

Freud showed that many sexual mysteries can be understood as critical-period fixations. After Freud, we are no longer surprised that the girl whose father left her as a child pursues unavailable men old enough to be her father, or that people raised by ice-queen mothers often seek such people out as partners, sometimes becoming “icy” themselves, because, never having experienced empathy in the critical period, a whole part of their brains failed to develop. And many perversions can be explained in terms of plasticity and the persistence of childhood conflicts. “Mothers I’d Like to F-ck” or “MILF” sites (e.g. while playing video games a young man is seduced by his best friend’s mother) Freud could fairly claim, are examples that many people have unresolved Oedipus complexes – and that many young men are far more attached to “the mother” than they are consciously aware of. (“MILF” along with “Teen” are the two most popular porn search terms used, according to PornHub and a study by Lucia O’Sullivan from the University of New Brunswick.)

But the main point is that in our critical periods we can acquire sexual and romantic tastes and inclinations that get wired into our brains and can have a powerful impact for the rest of our lives. And the fact that we can acquire different sexual tastes contributes to some of the tremendous sexual variation between us.

The idea that a critical period helps shape sexual desire in adults contradicts the currently popular argument that what attracts us is not so much the product of our personal history, but solely the effect of our common biology. Models and movie stars, for instance – are widely regarded as universally beautiful or sexy. A certain strand of biology teaches us that some people are attractive because they exhibit biological signs of robustness, which promise fertility and strength: a clear complexion and symmetrical features mean a potential mate is free from disease; an hourglass figure is a sign a woman is fertile; a man’s muscles predict he will be able to protect a woman and her offspring.

But this simplifies what biology really teaches. Not everyone falls in love with the body, as when a woman says, “I knew, when I first heard that voice, that he was for me”, the music of the voice being perhaps a better indication of a man’s soul than his body’s surface. And sexual taste has changed over the centuries. Rubens’s beauties were large by current standards, and over the decades the vital statistics of Playboy centrefolds and fashion models have varied from voluptuous to androgynous. Sexual taste is obviously influenced by culture and experience and is often acquired and then wired into the brain.

“Acquired tastes” are by definition learned, unlike “tastes”, which are inborn. A baby needn’t acquire a taste for milk, water, or sweets; these are immediately perceived as pleasant. Acquired tastes are initially experienced with indifference or dislike but later become pleasant – the odours of cheeses, Italian bitters, dry wines, coffees, pâtés, the hint of urine in a fried kidney. Many delicacies that people pay dearly for, that they must “develop a taste for”, are the very foods that disgusted them as children.

In Elizabethan times lovers were so enamoured of each other’s body odours that it was common for a woman to keep a peeled apple in her armpit until it had absorbed her sweat and smell. She would give this “love apple” to her lover to sniff at in her absence. We, on the other hand, use synthetic aromas of fruits and flowers to mask our body odour from our lovers. Many tastes we think “natural” are acquired through learning and become “second nature” to us. We are unable to distinguish our “second nature” from our “original nature” because our neuroplastic brains, once rewired, develop a new nature, every bit as biological as our original.

Pornography seems, at first glance, to be a purely instinctual matter, and it would seem that there is nothing acquired about it; sexually explicit pictures, of people in their most natural condition, nudity, trigger instinctual responses, which are the product of millions of years of evolution. Furthermore, the mammalian male’s interest in different partners, called “the Coolidge effect”, seems part of our evolutionary heritage. But if that were all there was to it, pornography would be unchanging, except for the fact that men would want new partners. The same triggers, body parts and their proportions, that appealed to our ancestors would excite us. This is what pornographers would have us believe, for they claim they are battling sexual repression, taboo and fear, and that their goal is to liberate the natural, pent-up sexual instincts.

But in fact the content of pornography is a dynamic phenomenon that perfectly illustrates the progress of an acquired taste. Thirty years ago “hardcore” pornography usually meant the explicit depiction of sexual intercourse between two aroused partners, displaying their genitals. “Softcore” meant pictures of women, mostly, on a bed, at their toilette, or in some semi-romantic setting, in various states of undress, breasts revealed.

Now hardcore has evolved and is increasingly dominated by the sadomasochistic themes of forced sex, ejaculations on women’s faces and angry anal sex, all involving scripts fusing sex with hatred and humiliation. Hardcore pornography now explores the world of perversion, while softcore is now what hardcore was a few decades ago, explicit sexual intercourse between adults, now available on cable TV. The comparatively tame softcore pictures of yesteryear – women in various states of undress – now show up on mainstream media all day long, in the pornification of everything, including television, rock videos, soap operas, advertisements and so on.

Pornography’s growth has been extraordinary; it is the fourth most common reason people give for going online. An MSNBC.com survey of viewers in 2001 found that 80 per cent felt they were spending so much time on pornographic sites that they were putting their relationships or jobs at risk.

The changes I and other psychiatrists observed were not confined to a few people in therapy. A social shift began occurring in the 1990s, around how the idea of “porn” was understood. While in the past it has often been difficult to get information about private sexual mores, this was not the case with pornography during that period, precisely because porn went from being somewhat of a private affair, to an increasingly public one.

This shift coincides with the change from calling it “pornography” to the more casual term “porn”. For his book, I Am Charlotte Simmons, Tom Wolfe spent a number of years observing students on university campuses. In the book one boy, Ivy Peters, comes into the male residence and says, “Anybody got porn?” One of the boys says, “Try the third floor. They got some one-hand magazines up there.” But Peters responds, “I’ve built up a tolerance to magazines… I need videos… I want porn. What’s the big deal?”

He recognises that he is “tolerant” like a drug addict who can no longer get high on the images that once turned him on. And the danger is that this tolerance will carry over into relationships, as it did in patients whom I was seeing, leading to potency problems and new, at times unwelcome, tastes. When pornographers boast that they are pushing the envelope by introducing new, harder themes, what they don’t say is that they must, because their customers are building up a tolerance to the content. The back pages of men’s risqué magazines and internet porn sites are filled with ads for Viagra-type drugs – medicine developed for older men with erectile problems related to ageing and blocked blood vessels in the penis. Today young men who surf porn are tremendously fearful of impotence, or “erectile dysfunction” as it is euphemistically called. The misleading term implies that these men have a problem in their penises, but the problem is in their heads, in their sexual brain maps. The penis works fine when they use pornography. It rarely occurs to them that there may be a relationship between the pornography they are consuming and their impotence. (A few men, however, tellingly described their hours at computer porn sites as time spent “masturbating my brains out”.) And this is because, as we shall see, pornography, delivered by high-speed internet connections, satisfies every one of the prerequisites for neuroplastic change, and is quite addictive.

The addictiveness of internet pornography is not a metaphor. Not all addictions are to drugs or alcohol. People can be seriously addicted to gambling, even to running. All addicts show a loss of control of the activity, compulsively seek it out despite negative consequences, develop tolerance so that they need higher and higher levels of stimulation for satisfaction, and experience withdrawal if they can’t consummate the addictive act.

All addiction involves long-term, sometimes lifelong, neuroplastic change in the brain. For addicts, moderation is almost always impossible, and they must avoid the substance or activity completely if they are to avoid addictive behaviours. Alcoholics Anonymous insists that there are no “former alcoholics” and makes people who haven’t had a drink for decades introduce themselves at a meeting by saying, “My name is John, and I am an alcoholic”. In terms of plasticity, they are often correct.

In order to determine how addictive a street drug is, researchers at the National Institutes of Health (NIH) in Maryland train a rat to press a bar until it gets a shot of the drug. The harder the animal is willing to work to press the bar, the more addictive the drug. Cocaine, almost all other illegal drugs, and even nondrug addictions such as running make the pleasure-giving neurotransmitter dopamine more active in the brain. Dopamine is called the reward transmitter, because when we accomplish something – run a race and win – our brain triggers its release. Though exhausted, we get a surge of energy, exciting pleasure and confidence, and even raise our hands and run a victory lap. The losers, on the other hand, who get no such dopamine surge, collapse at the finish line, and feel awful about themselves. By hijacking our dopamine system, addictive substances give us pleasure without our having to work for it.

Dopamine is also involved in plastic change. The same surge of dopamine that thrills us also consolidates the neuronal connections responsible for the behaviours that led us to accomplish our goal. When neuroscientist Michael Merzenich used an electrode to stimulate an animal’s dopamine reward system while playing a sound, dopamine release stimulated plastic change, enlarging the representation for the sound in the animal’s auditory map. An important link with porn is that dopamine is also released in sexual excitement, increasing the sex drive in both sexes, facilitating orgasm, and activating the brain’s pleasure centres. Hence the addictive power of pornography. Cambridge University neuropsychiatrist Dr Valerie Voon has recently shown that men who describe themselves as addicted to porn (and who lost relationships because of it) develop changes in the same brain area – the reward centre – that changes in drug addicts.

Eric Nestler, at the University of Texas, has shown how addictions cause permanent changes in the brains of animals. A single dose of many addictive drugs will produce a protein, called delta-FosB, that accumulates in the neurons. Each time the drug is used, more delta-FosB accumulates, until it throws a genetic switch, affecting which genes are turned on or off. Flipping this switch causes changes that persist long after the drug is stopped, leading to irreversible damage to the brain’s dopamine system and rendering the animal far more prone to addiction. Non-drug addictions, such as running and sucrose drinking, also can lead to the accumulation of delta-FosB and the same permanent changes in the dopamine system. Pornographers promise healthy pleasure and relief from sexual tension, but what they often deliver is an addiction, tolerance, and an eventual decrease in pleasure. Paradoxically, the male patients I worked with often craved pornography but didn’t like it. The usual view is that an addict goes back for more of his fix because he likes the pleasure it gives and doesn’t like the pain of withdrawal. But addicts take drugs when there is no prospect of pleasure, when they know they have an insufficient dose to make them high, and will crave more even before they begin to withdraw. Wanting and liking are two different things.

An addict experiences cravings because his plastic brain has become sensitised to the drug or the experience. Sensitisation is different from tolerance. As tolerance develops, the addict needs more and more of a substance or porn to get a pleasant effect; as sensitisation develops, he needs less and less of the substance to crave it intensely. So sensitisation leads to increased wanting, though not necessarily liking. It is the accumulation of delta-FosB, caused by exposure to an addictive substance or activity, that leads to sensitisation.

Pornography is more exciting than satisfying because we have two separate pleasure systems in our brains, one that has to do with exciting pleasure and one with satisfying pleasure. The exciting system relates to the “appetitive” pleasure that we get imagining something we desire, such as sex or a good meal. Its neurochemistry is largely dopamine-related, and it raises our tension level.

The second pleasure system has to do with the satisfaction, or consummatory pleasure, that attends actually having sex or having that meal, a calming, fulfilling pleasure. Its neurochemistry is based on the release of endorphins, which are related to opiates and give a peaceful, euphoric bliss. Porn hyperactivates the appetitive system by offering an endless harem of sexual objects.

The men at their computers, who I and others were treating in the 1990s, looking at porn were uncannily like the rats in the cages of the NIH, pressing the bar to get a shot of dopamine or its equivalent. Though they didn’t know it, they had been seduced into pornographic training sessions that met all the conditions required for plastic change of brain maps. Since neurons that fire together wire together, these men got massive amounts of practice wiring these images into the pleasure centres of the brain, with the rapt attention necessary for plastic change. They imagined these images when away from their computers, or while having sex with their girlfriends, reinforcing them. Each time they felt sexual excitement and had an orgasm when they masturbated, a “spritz of dopamine”, the reward neurotransmitter, consolidated the connections made in the brain during the sessions. Not only did the reward facilitate the behaviour; it provoked none of the embarrassment they might have felt purchasing Playboy at a store. Here was a behaviour with no “punishment”, only reward. Because plasticity is competitive, the brain maps for new, exciting images increased at the expense of what had previously attracted them – the reason, I believe, they began to find their girlfriends less of a turn-on.

The story of Sean Thomas, first published in England’s Spectator, is a remarkable account of a man descending into a porn addiction, and it sheds light on how porn changes brain maps and alters sexual taste, as well as the role of critical-period plasticity in the process. Thomas wrote, “I never used to like pornography, not really. Yes, in my teens in the Seventies I used to have the odd copy of Playboy under my pillow. But on the whole I didn’t really go for skin mags or blue movies.

I found them tedious, repetitive, absurd, and very embarrassing to buy.” He was repelled by the bleakness of the porn scene and the garishness of the moustachioed studs who inhabited it. But in 2001, shortly after he first went online, he got curious about the porn everyone said was taking over the internet. Many of the sites were free – teasers, or “gateway sites”, to get people into the harder stuff. There were galleries of naked girls, of common types of sexual fantasies and attractions, designed to press a button in the brain of the surfer, even one he didn’t know he had. Thomas found they “dragged me back for more the next day. And the next. And the next.”

Then one day he came across a site that featured spanking images. To his surprise, he got intensely excited. Thomas soon found all sorts of related sites, such as “Bernie’s Spanking Pages” and the “Spanking College”. “This was the moment,” he writes, “that the real addiction set in. My interest in spanking got me speculating: What other kinks was I harbouring? What other secret and rewarding corners lurked in my sexuality that I would now be able to investigate in the privacy of my home? Plenty, as it turned out. I discovered a serious penchant for, inter alia, lesbian gynaecology, interracial hardcore, and images of Japanese girls taking off their hot pants. I was also into netball players with no knickers, drunk Russian girls exposing themselves, and convoluted scenarios where submissive Danish actresses were intimately shaved by their dominant female partners in the shower. The net had, in other words, revealed to me that I had an unquantifiable variety of sexual fantasies and quirks and that the process of satisfying these desires online only led to more interest.”

Until he happened upon the spanking pictures, which presumably tapped into some childhood experience or fantasy about being punished, the images he saw interested him but didn’t compel him. Other people’s sexual fantasies bore us. Thomas’s experience was similar to that of my patients: without being fully aware of what they were looking for, they scanned hundreds of images and scenarios until they hit upon an image or sexual script that touched some buried theme that really excited them.

Once Thomas found that image, he changed. That spanking image had his focused attention, the condition for plastic change. And unlike a real woman, these porn images were available all day, every day on the computer.

He tried to control himself but was spending at least five hours a day secretly surfing, sleeping only three hours a night. His girlfriend, aware of his exhaustion, wondered if he was seeing someone else. He became so sleep deprived that his health suffered, and he got a series of infections that landed him in a hospital emergency room and finally caused him to take stock. He began inquiring among his male friends and found that many of them were also hooked.

Clearly there was something about Thomas’s sexuality, outside his awareness, that had suddenly surfaced. Does the net simply reveal quirks and kinks, or does it also help create them? I think it creates new fantasies out of aspects of sexuality that have been outside the surfer’s conscious awareness, bringing these elements together to form new networks. It is not likely that many men have witnessed, or even imagined, submissive Danish actresses intimately shaved by their dominant female partners in the shower. Freud discovered that such fantasies take hold of the mind because of the individual components in them. For instance, some heterosexual men are interested in porn scenarios where older, dominant women initiate younger women into lesbian sex. This may be because boys in early childhood often feel dominated by their mothers, who are the “boss”, and dress, undress and wash them. In early childhood some boys may pass through a period when they strongly identify with their mothers and feel “like a girl”, and their later interest in lesbian sex can express their residual unconscious female identification. Hardcore porn unmasks some of the early neural networks that formed in the critical periods of sexual development and brings all these early, forgotten, or repressed elements together to form a new network, in which all the features are wired together. Porn sites generate catalogues of common kinks and mix them together in images. Sooner or later the surfer finds a killer combination that presses a number of his sexual buttons at once. Then he reinforces the network by viewing the images repeatedly, masturbating, releasing dopamine and strengthening these networks. He has created a kind of “neosexuality”, a rebuilt libido that has strong roots in his buried sexual tendencies. Because he often develops tolerance, the pleasure of sexual discharge must be supplemented with the pleasure of an aggressive release, and sexual and aggressive images are increasingly mingled – hence the increase in sadomasochistic themes in hardcore porn.

The rewiring of our pleasure systems, and the extent to which our sexual tastes can be acquired, is seen most dramatically in such perversions as sexual masochism, which turns physical pain into sexual pleasure. To do this the brain must make pleasant that which is inherently unpleasant, and the impulses that normally trigger our pain system are plastically rewired into our pleasure system.

People with perversions often organise their lives around activities that mix aggression and sexuality, and they often celebrate and idealise humiliation, hostility, defiance, the forbidden, the furtive, the lusciously sinful and the breaking of taboos; they feel special for not being merely “normal”. These “transgressive” or defiant attitudes are essential to the enjoyment of perversion.

Sexual sadism illustrates plasticity in that it fuses two familiar tendencies, the sexual and the aggressive, each of which can give pleasure separately, and brings them together so when they are discharged, the pleasure is doubled. But masochism – often seen in people who have been seriously traumatised – goes much further because it takes something inherently unpleasant, pain, and turns it into a pleasure, altering the sexual drive more fundamentally and more vividly, demonstrating the plasticity of our pleasure and pain systems.

That all-purpose Canadian genius, Marshall McLuhan, often quipped that the medium is the message. In an age where media gurus are everywhere, few really comprehend, as he did, that the media change us, master us, and not the other way around. Our media gurus think it is we that are in charge.

I have said that the patients in the 1990s who were among the first to use internet porn (and thus could compare its influence, as Thomas did, to the earlier girlie magazines) often got turned on as they passed by their computers, even if they were off. Their libidos became attached to the medium.

In her book, Bunny Tales: Behind Close Doors at the Playboy Mansion, Izabella St James, who was one of Hugh Hefner’s former “official girlfriends”, described sex with Hef. Hef, in his late 70s, would have sex twice a week, sometimes with four or more of his girlfriends at once, St James among them. He had novelty, variety, multiplicity and women willing to do what he pleased. At the end of the happy orgy, wrote St James, came “the grand finale: he masturbated while watching porn”.

Here, the man who could actually live out the ultimate porn fantasy, with real porn stars, instead turned from their real flesh and touch, to the image on the screen. Some might say, “Give the old man a break”, he was in his late seventies, perhaps he needed a little help to orgasm. But that objection misses the point, which is that what helped him was not beautiful porn stars, but celluloid images of them, once removed. It was, I suggest, a powerful example of how a sexual taste for a real person becomes supplanted by the medium that represents that person at a remove.

As for the patients who became involved in porn, most were able to go cold turkey once they understood the problem and how they were plastically reinforcing it. They found eventually that they were attracted once again to their mates. None of these men had addictive personalities or serious childhood traumas, and when they understood what was happening to them, they stopped using their computers for a period to weaken their problematic neuronal networks, and their appetite for porn radically decreased. Some of them were probably experiencing a combination of mild addiction, facilitated by a biological phenomenon: the so-called Coolidge effect, where male mammals, already sexually satisfied, have sexual interest quickly re-excited by a new receptive partner. This may be built into males, by evolution, to maximise their reproductive chances. By not using their computer for porn, for an extended period, they both eliminated temptation and engaged another neuroplastic law: neurons that fire apart wire apart, which can be used to break an unwanted habit.

If the person who is over-involved in internet porn is someone who has had a partner, or partners, but also has an addictive tendency, they might require not just knowledge of how the additive cycle works, but various interventions, that have been helpful in other addictions.

Regaining control can be complicated for patients who, in their critical periods, acquired a preference for problematic sexual types, and then found these interests re-ignited, by triggers in the porn. (Think of “spanking” as a possible trigger, of a childhood trauma.) Such men, when in therapy, were able to analyse the meaning of the new triggers, to learn why they had such a grip on them, and loosen that grip. (It is not uncommon when people have unresolved traumas, that they, to master the painful emotions they trigger, find a way to make them more “pleasant”. Since sexual excitement and discharge is so pleasant, fantasies about the traumas are often “sexualised”. They become a “turn-on”.) Yet even some of these men were able to change their sexual type, in the course of therapy, because the same laws of neuroplasticity that allow us to acquire problematic tastes also allow us, in intensive treatment, to acquire newer, healthier ones and in some cases even to lose our older, troubling ones. We are only beginning to learn, from science, how recoveries from addictions take place. Basically, a sustained abstinence period is required for the brain’s reward centre to return towards normal when in the presence of the addictive trigger,. But it is possible some residual sensitivity remains, as in the delta-FosB situation described above. Since sexual excitement itself is a normal phenomenon, not a drug, until we have studies of recovering porn addicts, we won’t know for sure.

It is a very different situation when dealing with someone for whom sexuality has almost always and only been tied into sadomasochism, and who doesn’t see himself as having a problem. Such a person is not acquiring a sexual taste when using porn, but reinforcing an existing one. It is important to keep in mind not only the addictive behaviour, but who harbours it. Some men believe that they have few prospects in the competition for attractive and healthy partners. Perhaps they see themselves as struggling with work, social status, or health issues, believe themselves “ugly”. They believe themselves to be “low in the dominance hierarchy”, and that this renders them less attractive as mates for others. They may withdraw from courtship, in despair. For them, the life of porn easily becomes a substitute for sex in a relationship. It feels to them, “the best they can do”. Helping them requires helping them learn to deal with the issues that make them feel like “losers”.

Needless to say, young teenagers, because of their inexperience, often feel that they are low in the hierarchy, as they conceive it, of desirable mates. What clinicians don’t yet know much about, yet, is how we shall help teenagers, whose sexual tastes are being influenced by porn, because this level of porn exposure is quite new. Will these influences and tastes turn out to be superficial? Or will the new porn scenarios deeply embed themselves because the teen years are still a formative period?

Human beings, like the boy in InRealLife, are not simply rats in cages, like the specimens at the National Institutes of Health. That boy expressed distress at what the porn exposure was doing to him. We can hope, as teens discuss this more openly, as that boy did, that they will take action. Today, there are a number of websites springing up for teenagers and young men, who report that going cold turkey seems to be working for them. Not all addictions are of the same magnitude; and some seem reversible. It’s a use-it-or-lose-it brain, even where sexual desire and love are concerned. This means that decisions these boys make shape not only the actions they take, at a given time, but the shape and structure of their brains, over the long haul. That realisation, alone, may be enough to cause them to spend more time thinking about what is the wisest course to take.

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